以支架和内镜真空疗法为基础的治疗后的结果,用于排泄后食道破裂
Tommy Kallåk Anundsen1, Dag Tidemann Førland1, Hans-Olaf Johannessen1
1Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Ullevål, Oslo, Norway.
Scandinavian journal of gastroenterology
|August 18, 2023
概括
使用内镜支架密封和内镜真空疗法 (EVT) 治疗Boerhaave综合征的最小侵入性治疗显示出有希望的结果. 这种方法,结合横胸疏通,在患有食道破裂的患者中实现了低死亡率和良好的功能结果.
科学领域:
- 胃肠病学 胃肠病学
- 胸部外科手术 胸部外科手术
- 最少侵入性手术的方法
背景情况:
- 自发食道破裂 (Boerhaave综合征) 传统上需要广泛的手术修复.
- 越来越多地采用微创技术,特别是内镜式支架密封.
- 内镜真空疗法 (EVT) 是一种新兴的食道穿孔治疗方法.
研究的目的:
- 评估内镜支架和/或基于EVT治疗Boerhaave综合征的疗效和结果.
- 在7年的时间内评估这些微创方法的安全性和功能结果.
主要方法:
- 连续17名Boerhaave综合征患者 (2015年6月 - 2022年5月) 的回顾性分析.
- 穿孔被使用内镜支架和/或EVT密封.
- 胃排泄物通过胸腔管或猪尾导管进行了胸腔外排水.
主要成果:
- 观察到90天死亡率为6%.
- 所有患者的穿孔都愈合了,88%的患者出现并发症,如多器官功能衰竭和多脉.
- 尽管对泄漏或支架迁移进行了重复手术,但14名患者 (82%) 长期存活,没有食障碍或显著疲劳.
结论:
- 内镜支架和基于EVT的治疗,再加上胸外排水,为Boerhaave综合征提供了低死亡率的选择.
- 虽然并发症和重复干预很常见,但功能结果仍然有利.
- 最少的侵入性策略是有效的管理食道穿孔.
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